| NPI | 1033716840 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: OH 03233313) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: WV RP0008113) |
| Enumeration Date | 2020-10-05 |
| Last Update Date | 2026-02-10 |