| NPI | 1659791200 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: OH 03129451) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: FL Ps47200) |
| 183500000X Pharmacist (Licence: SC 14358) | |
| Enumeration Date | 2014-04-22 |
| Last Update Date | 2024-08-21 |