| NPI | 1174842702 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: OH 06006409) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: KY I08346) |
| Enumeration Date | 2010-05-21 |
| Last Update Date | 2010-05-21 |