| NPI | 1124452685 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MI 5302040358) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: OH 03331310) |
| Enumeration Date | 2013-09-02 |
| Last Update Date | 2013-09-02 |