| NPI | 1578921227 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: KY 011952) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: FL ps50605) |
| 183500000X Pharmacist (Licence: OH 03117472) | |
| Enumeration Date | 2016-02-09 |
| Last Update Date | 2016-02-09 |