| NPI | 1215603071 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: PA RP037396L) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: OH 03-3-22598) |
| 183500000X Pharmacist (Licence: FL PS48720) | |
| Enumeration Date | 2021-08-20 |
| Last Update Date | 2021-08-20 |