| NPI | 1104207950 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: TN 39544) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: OH 03232699) |
| Enumeration Date | 2015-06-17 |
| Last Update Date | 2023-01-25 |