| NPI | 1750099875 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: IA 24736) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: OH 03442688) |
| Enumeration Date | 2022-11-08 |
| Last Update Date | 2023-08-14 |