| NPI | 1710295340 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: OR 0012403) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: OH 03230522) |
| Enumeration Date | 2010-09-16 |
| Last Update Date | 2010-09-16 |