| NPI | 1568857134 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1835P2201X Pharmacist, Ambulatory Care (Licence: WA PH60561814) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: OH 03234108) |
| Enumeration Date | 2015-04-01 |
| Last Update Date | 2016-11-02 |