| NPI | 1508538315 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: OH 03131774) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: PA RP446672) |
| Enumeration Date | 2021-09-30 |
| Last Update Date | 2021-09-30 |