| NPI | 1205002540 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MI 5302032300) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: OH 03-2-23061) |
| Enumeration Date | 2008-05-06 |
| Last Update Date | 2008-05-06 |