| NPI | 1003027665 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MI 5302026084) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: OH 03-2-09074) |
| 183500000X Pharmacist (Licence: AZ 9578) | |
| Enumeration Date | 2007-05-25 |
| Last Update Date | 2024-08-26 |