| NPI | 1619456381 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: TX 64702) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: OH 03337383) |
| Enumeration Date | 2018-08-13 |
| Last Update Date | 2024-04-25 |