| NPI | 1720362114 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MT 5734) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: OH 03-1-17452) |
| 183500000X Pharmacist (Licence: SC 10045) | |
| Enumeration Date | 2011-10-04 |
| Last Update Date | 2011-10-04 |