| NPI | 1558395186 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: OH 03-3-15914) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NH 2035) |
| 183500000X Pharmacist (Licence: MI 5302022691) | |
| 183500000X Pharmacist (Licence: MA 16616) | |
| Enumeration Date | 2006-07-10 |
| Last Update Date | 2007-07-08 |