| NPI | 1467064907 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: KS 1-106401) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MO 2018035553) |
| 183500000X Pharmacist (Licence: KY 019292) | |
| 183500000X Pharmacist (Licence: OH 03226254) | |
| Enumeration Date | 2020-08-17 |
| Last Update Date | 2020-08-17 |