| NPI | 1710268255 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MI 5302039996) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: OH 03230254) |
| Enumeration Date | 2011-08-29 |
| Last Update Date | 2011-08-29 |