| NPI | 1639372774 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: OH 03-1-22754) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MI 040973) |
| Enumeration Date | 2007-06-07 |
| Last Update Date | 2015-02-27 |