| NPI | 1366834814 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: KY 017339) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: OH 03333877) |
| 183500000X Pharmacist (Licence: IN 26025530A) | |
| Enumeration Date | 2015-02-20 |
| Last Update Date | 2019-02-15 |