| NPI | 1053721928 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1835P1200X Pharmacist, Pharmacotherapy (Licence: OH 03219693) |
| Additional Taxonomies | 1835P1200X Pharmacist, Pharmacotherapy (Licence: MI 5302028776) |
| Enumeration Date | 2014-05-01 |
| Last Update Date | 2014-05-01 |