| NPI | 1770036576 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: OH 03132245) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MI 5302041443) |
| 1835P2201X Pharmacist Ambulatory Care (Licence: OH 03132245) | |
| 1835P2201X Pharmacist Ambulatory Care (Licence: MI 5302041443) | |
| Enumeration Date | 2016-07-27 |
| Last Update Date | 2016-07-27 |