| NPI | 1073922050 |
|---|---|
| Former Name | JORDAN WITTE |
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: CO 22679) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: WY 3760) |
| Enumeration Date | 2014-08-04 |
| Last Update Date | 2024-02-19 |