| NPI | 1255711321 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: PA RP448602) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: WV RP0008607) |
| 183500000X Pharmacist (Licence: OH RPH.03233596) | |
| Enumeration Date | 2015-06-04 |
| Last Update Date | 2019-07-15 |