| NPI | 1700553872 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: WV RP0013330) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: OH 03441104) |
| Enumeration Date | 2021-08-26 |
| Last Update Date | 2023-02-09 |