| NPI | 1104426808 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: OH 031226020) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MI 5302034111) |
| 183500000X Pharmacist (Licence: NV 16450) | |
| 183500000X Pharmacist (Licence: TX 52833) | |
| 183500000X Pharmacist (Licence: OR 13455) | |
| Enumeration Date | 2020-10-30 |
| Last Update Date | 2020-10-30 |