| NPI | 1710358783 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: OH RPH.03233062-2) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: FL PS53204) |
| Enumeration Date | 2015-10-15 |
| Last Update Date | 2015-10-15 |