| NPI | 1811550098 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: CO PHA.0020928) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: OH 03237022) |
| Enumeration Date | 2019-04-15 |
| Last Update Date | 2019-04-15 |