| NPI | 1225393150 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: GA 12040) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: OH 03218196) |
| Enumeration Date | 2012-07-06 |
| Last Update Date | 2012-07-06 |