| NPI | 1720357296 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: AZ S015842) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: CA 59228) |
| 183500000X Pharmacist (Licence: OH 03127300) | |
| Enumeration Date | 2011-12-29 |
| Last Update Date | 2025-08-20 |