| NPI | 1457519811 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: TX 39207) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: OH 03-3-21918) |
| Enumeration Date | 2008-06-01 |
| Last Update Date | 2008-06-01 |