| NPI | 1053838490 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: OH 03439605) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NV 21679) |
| 183500000X Pharmacist (Licence: NJ 28RI03958700) | |
| 183500000X Pharmacist (Licence: MO 2017028036) | |
| Enumeration Date | 2017-08-25 |
| Last Update Date | 2023-08-10 |