| NPI | 1346831542 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: OH 03136249) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NY 061667) |
| Enumeration Date | 2021-01-30 |
| Last Update Date | 2021-01-30 |