| NPI | 1568752517 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: OH RPH.03129992-1) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NJ 28RI03328700) |
| Enumeration Date | 2011-04-12 |
| Last Update Date | 2011-04-12 |