| NPI | 1154729663 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: SC 14084) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: OH 03-3-18416) |
| Enumeration Date | 2014-12-15 |
| Last Update Date | 2014-12-15 |