| NPI | 1376662452 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: AZ 14273) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: OH 03-1-11013) |
| Enumeration Date | 2007-03-28 |
| Last Update Date | 2007-07-08 |