| NPI | 1164973194 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: OH 03233964) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: CA 75244) |
| Enumeration Date | 2016-10-14 |
| Last Update Date | 2017-04-28 |