| NPI | 1073154910 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1835P1200X Pharmacist Pharmacotherapy (Licence: FL PS46345) |
| Additional Taxonomies | 1835P1200X Pharmacist Pharmacotherapy (Licence: OH 03230310) |
| Enumeration Date | 2019-10-02 |
| Last Update Date | 2019-10-09 |