| NPI | 1720367469 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MI 5302039927) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: OH 03330971) |
| Enumeration Date | 2011-08-11 |
| Last Update Date | 2011-08-11 |