| NPI | 1083905657 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: OH 03329036) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: PA rp045404r) |
| 183500000X Pharmacist (Licence: VA 0202012513) | |
| Enumeration Date | 2011-04-29 |
| Last Update Date | 2011-04-29 |