| NPI | 1255549309 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: OH 03-2-26638) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: GA GA016049) |
| 183500000X Pharmacist (Licence: FL PS25134) | |
| Enumeration Date | 2007-05-21 |
| Last Update Date | 2007-07-08 |