| NPI | 1417569161 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: OH 03439979) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NM RP00009333) |
| Enumeration Date | 2020-08-22 |
| Last Update Date | 2020-08-22 |