| NPI | 1902112766 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NV 18446) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: OH RPH.03131996-1) |
| Enumeration Date | 2010-08-30 |
| Last Update Date | 2017-04-10 |