| NPI | 1851642722 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: AZ S019107) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: OH 03228270) |
| Enumeration Date | 2012-10-01 |
| Last Update Date | 2015-03-04 |