| NPI | 1306403274 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: TN 42253) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: OH 03337236) |
| Enumeration Date | 2019-05-24 |
| Last Update Date | 2019-05-24 |