| NPI | 1417380130 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1835P0018X Pharmacist Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist (Licence: WV RP0008048) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: OH RPH.03132436-1) |
| 183500000X Pharmacist (Licence: KY 012518) | |
| Enumeration Date | 2013-08-16 |
| Last Update Date | 2020-01-12 |