| NPI | 1427572296 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NY 064763) |
| Additional Taxonomies | 1835P2201X Pharmacist, Ambulatory Care (Licence: OH 03236868) |
| Enumeration Date | 2017-08-02 |
| Last Update Date | 2018-11-07 |