| NPI | 1346851912 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: WI 22391) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: OH 03440000) |
| 183500000X Pharmacist (Licence: TX 63115) | |
| Enumeration Date | 2020-08-16 |
| Last Update Date | 2024-08-28 |