| NPI | 1982208658 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: OH 03440351) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: PA RP454428) |
| 183500000X Pharmacist (Licence: WV RP0011742) | |
| Enumeration Date | 2020-11-24 |
| Last Update Date | 2024-09-18 |