| NPI | 1174809768 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: OH 03132067-1) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: TX 49998) |
| Enumeration Date | 2011-10-26 |
| Last Update Date | 2016-10-26 |