| NPI | 1144633009 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: OH 03331199) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MI 5302040000) |
| Enumeration Date | 2014-06-09 |
| Last Update Date | 2014-06-09 |