| NPI | 1588077168 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: KY 015018) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: OH 03230375) |
| Enumeration Date | 2014-06-11 |
| Last Update Date | 2020-08-14 |