| NPI | 1609436179 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: OH 03438865) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: CT PCT.0014420) |
| Enumeration Date | 2019-06-17 |
| Last Update Date | 2019-12-16 |