| NPI | 1215601216 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: OH 03131695) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MI 5302046351) |
| Enumeration Date | 2021-08-03 |
| Last Update Date | 2021-08-03 |