| NPI | 1356944839 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: OH 03-1-22770) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: TX 64136) |
| Enumeration Date | 2020-11-18 |
| Last Update Date | 2020-11-18 |