| NPI | 1700388261 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: OH 03237125) |
| Additional Taxonomies | 1835P2201X Pharmacist, Ambulatory Care (Licence: ND RPh6061) |
| Enumeration Date | 2018-03-01 |
| Last Update Date | 2018-07-31 |