| NPI | 1780128363 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: OH 03135309) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: CT PCT.0012937) |
| Enumeration Date | 2016-12-15 |
| Last Update Date | 2019-09-27 |