| NPI | 1144463514 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: TX 45217) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: OH 03227848) |
| Enumeration Date | 2009-04-14 |
| Last Update Date | 2010-09-24 |