| NPI | 1063619955 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: OH 03-1-26036) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: GA RPH020951) |
| Enumeration Date | 2007-07-02 |
| Last Update Date | 2007-07-08 |