| NPI | 1841893633 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: WA PH61289517) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: OH 03439937) |
| 183500000X Pharmacist (Licence: WV RP0012756) | |
| Enumeration Date | 2020-11-16 |
| Last Update Date | 2022-08-05 |