| NPI | 1689346512 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: OH 03441089) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MN 125359) |
| Enumeration Date | 2021-09-29 |
| Last Update Date | 2021-09-29 |