| NPI | 1386199487 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: OH 03136202) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MD 23397) |
| Enumeration Date | 2016-08-18 |
| Last Update Date | 2016-08-18 |