| NPI | 1588104913 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: OH 03233300) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: TX 60124) |
| 183500000X Pharmacist (Licence: NJ 28RI03777300) | |
| Enumeration Date | 2017-03-04 |
| Last Update Date | 2017-03-04 |