| NPI | 1750972055 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: OH 03124681) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: KY 017573) |
| Enumeration Date | 2021-01-29 |
| Last Update Date | 2021-01-29 |