| NPI | 1548541659 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: KY 013622) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: OH 03228063) |
| Enumeration Date | 2011-09-01 |
| Last Update Date | 2014-01-29 |