| NPI | 1841580636 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: OH 03129703) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: TX 49344) |
| Enumeration Date | 2011-04-13 |
| Last Update Date | 2012-01-10 |