| NPI | 1720363518 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: PA RP038086R) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: PA RPI001500) |
| 183500000X Pharmacist (Licence: OH 03216378) | |
| Enumeration Date | 2011-10-12 |
| Last Update Date | 2011-10-12 |