| NPI | 1801311972 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: OH 03135978) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: TN 0000043675) |
| Enumeration Date | 2017-08-09 |
| Last Update Date | 2019-08-15 |