| NPI | 1952700569 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: AL 17674) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: WI 17647-40) |
| 183500000X Pharmacist (Licence: OH 03334654-3) | |
| Enumeration Date | 2014-08-19 |
| Last Update Date | 2016-02-23 |