| NPI | 1790915452 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: OH 03324134) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NV 14929) |
| Enumeration Date | 2009-07-15 |
| Last Update Date | 2009-07-15 |