| NPI | 1790273175 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: GA 030089) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: OH 03331404) |
| Enumeration Date | 2018-05-01 |
| Last Update Date | 2018-05-01 |