| NPI | 1538882345 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: CO 0024590) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: OH 03237452) |
| 183500000X Pharmacist (Licence: TX 67472) | |
| Enumeration Date | 2022-09-26 |
| Last Update Date | 2024-01-24 |