| NPI | 1639165301 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: FL PS12775) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: OH 03-2-09518) |
| Enumeration Date | 2005-09-27 |
| Last Update Date | 2007-07-08 |