| NPI | 1558681809 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: OH 03129341) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: SC 37331) |
| 183500000X Pharmacist (Licence: MO 2010035373) | |
| 183500000X Pharmacist (Licence: NC 23808) | |
| Enumeration Date | 2010-06-09 |
| Last Update Date | 2017-10-20 |