| NPI | 1669547121 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: AZ S016943) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: OH 03-3-10561) |
| 183500000X Pharmacist (Licence: NV 10246) | |
| Enumeration Date | 2006-11-21 |
| Last Update Date | 2009-03-18 |