| NPI | 1952676140 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: WI 14589040) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: OH 03325450) |
| Enumeration Date | 2012-03-20 |
| Last Update Date | 2012-03-20 |