| NPI | 1710263280 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: OH 03132538) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: WI 16000-40) |
| Enumeration Date | 2011-10-28 |
| Last Update Date | 2013-08-09 |