| NPI | 1659653863 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: OH 03338020) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MI 5302035266) |
| 183500000X Pharmacist (Licence: VA 0202207286) | |
| Enumeration Date | 2011-09-13 |
| Last Update Date | 2019-03-07 |