| NPI | 1508239112 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: MI 4351048582) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: OH 03334968) |
| 183500000X Pharmacist (Licence: MI 5302045831) | |
| 207P00000X Emergency Medicine (Licence: MI 4351048582) | |
| Enumeration Date | 2015-11-04 |
| Last Update Date | 2021-06-15 |