| NPI | 1982652251 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1835P0018X Pharmacist, Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist (Licence: NY 049180) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NY 049180) |
| 183500000X Pharmacist (Licence: OH 03-3-25457) | |
| Enumeration Date | 2006-05-05 |
| Last Update Date | 2012-10-09 |