| NPI | 1700260080 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NM RP00008349) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: OH 03131941) |
| 183500000X Pharmacist (Licence: KY 016120) | |
| Enumeration Date | 2015-07-16 |
| Last Update Date | 2015-07-16 |