| NPI | 1083038020 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MD 21869) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: OH 03236433) |
| Enumeration Date | 2014-02-11 |
| Last Update Date | 2024-07-25 |