| NPI | 1902556830 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: CO PHA.0023266) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: OH 03132149) |
| 183500000X Pharmacist (Licence: KY 019222) | |
| Enumeration Date | 2022-03-24 |
| Last Update Date | 2022-03-24 |