| NPI | 1568917813 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: IA 22850) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: OH 03135922) |
| Enumeration Date | 2016-08-16 |
| Last Update Date | 2016-08-16 |