| NPI | 1356727960 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: OH 03233972) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: OR RPH-0014682) |
| 183500000X Pharmacist (Licence: PA RP449261) | |
| Enumeration Date | 2015-08-05 |
| Last Update Date | 2018-01-16 |