| NPI | 1205202983 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: OH RPH.03233538-2) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: TX 45878) |
| 183500000X Pharmacist (Licence: WI 13459-40) | |
| Enumeration Date | 2015-08-17 |
| Last Update Date | 2015-08-17 |