| NPI | 1629359401 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: PA RP442282) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: OH 03227974) |
| 183500000X Pharmacist (Licence: PA RPI000458) | |
| Enumeration Date | 2011-09-07 |
| Last Update Date | 2011-09-07 |