| NPI | 1184000895 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: OH 03334708-3) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: WI 17892-40) |
| Enumeration Date | 2015-08-04 |
| Last Update Date | 2015-08-04 |