| NPI | 1467792689 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: WA PH00063526) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: OH RPH.03119032-1) |
| Enumeration Date | 2013-02-25 |
| Last Update Date | 2013-02-25 |