| NPI | 1962057083 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: OH 03337465) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NJ 28RI03995800) |
| Enumeration Date | 2019-08-06 |
| Last Update Date | 2019-08-06 |