| NPI | 1689888539 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: OH 03-2-11305) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: FL ps31217) |
| 183500000X Pharmacist (Licence: PA rp-041131-r) | |
| Enumeration Date | 2007-05-10 |
| Last Update Date | 2007-07-08 |