| NPI | 1871010108 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: OH 03237128) |
| Additional Taxonomies | 1835P0200X Pharmacist, Pediatrics (Licence: MN 123528) |
| Enumeration Date | 2017-08-28 |
| Last Update Date | 2021-02-18 |