| NPI | 1558967406 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1835P1200X Pharmacist Pharmacotherapy (Licence: OH 03135475) |
| Additional Taxonomies | 1835P1200X Pharmacist Pharmacotherapy (Licence: NY 061784) |
| Enumeration Date | 2020-12-07 |
| Last Update Date | 2023-10-17 |