| NPI | 1003115205 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: OH 03-2-13286) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: FL PS 20025) |
| Enumeration Date | 2011-03-28 |
| Last Update Date | 2011-03-28 |