| NPI | 1154512903 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: AZ 11834) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: OH 03315816) |
| 183500000X Pharmacist (Licence: MI 5302022110) | |
| Enumeration Date | 2007-08-07 |
| Last Update Date | 2007-08-07 |