| NPI | 1134621261 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1835P2201X Pharmacist, Ambulatory Care (Licence: OR RPH-0016706) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: OR RPH-0016706) |
| 183500000X Pharmacist (Licence: OH 03237491) | |
| 183500000X Pharmacist (Licence: WV RP0010235) | |
| Enumeration Date | 2018-03-05 |
| Last Update Date | 2018-08-08 |