| NPI | 1770674772 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: WA PH00067205) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: OH 03-1-27448) |
| Enumeration Date | 2006-09-27 |
| Last Update Date | 2018-04-09 |