| NPI | 1033783709 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1835P2201X Pharmacist Ambulatory Care (Licence: OH 03127443) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: OH 03127443) |
| Enumeration Date | 2021-05-18 |
| Last Update Date | 2025-04-04 |