| NPI | 1902892920 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | |
| Primary Taxonomy | 183500000X Pharmacist (Licence: OH 03-2-25231) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: IN 26017646A) |
| 183500000X Pharmacist (Licence: MI 5302032860) | |
| Enumeration Date | 2005-09-26 |
| Last Update Date | 2007-07-08 |