| NPI | 1497035968 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: OH 03129695) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: IN 26023944a) |
| Enumeration Date | 2011-08-27 |
| Last Update Date | 2012-03-30 |