| NPI | 1972916708 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MI 5302032003) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: OH 03126067) |
| 183500000X Pharmacist (Licence: NV 19387) | |
| Enumeration Date | 2014-06-10 |
| Last Update Date | 2026-05-31 |