| NPI | 1164802641 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: PA RP449072) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: OH RPH.03334328-3) |
| Enumeration Date | 2015-06-01 |
| Last Update Date | 2015-06-01 |