| NPI | 1558887562 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MI 5302042131) |
| Additional Taxonomies | 1835P2201X Pharmacist Ambulatory Care (Licence: OH 03338043) |
| Enumeration Date | 2017-08-22 |
| Last Update Date | 2023-03-01 |