| NPI | 1457905127 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: CA 82588) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: OH 03438640) |
| 183500000X Pharmacist (Licence: NV 20561) | |
| Enumeration Date | 2019-07-30 |
| Last Update Date | 2021-07-13 |