| NPI | 1205177011 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: TX 48245) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: OH 03213757) |
| Enumeration Date | 2013-03-05 |
| Last Update Date | 2013-03-05 |