| NPI | 1649792110 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: OH 03136284) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NY 061250) |
| Enumeration Date | 2017-07-17 |
| Last Update Date | 2018-03-17 |