| NPI | 1386128700 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: CO PHA.0023568) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: OH 03232883) |
| Enumeration Date | 2018-09-21 |
| Last Update Date | 2022-04-05 |