| NPI | 1023619368 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: OH 03236667) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MI 5302043713) |
| Enumeration Date | 2020-11-03 |
| Last Update Date | 2020-11-20 |