| NPI | 1164493219 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: TX 49817) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: VA 0202206459) |
| 183500000X Pharmacist (Licence: OH 03-3-27156) | |
| Enumeration Date | 2006-01-27 |
| Last Update Date | 2025-02-18 |