| NPI | 1043813397 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: OH 03221552) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MI 5302414087) |
| Enumeration Date | 2020-11-19 |
| Last Update Date | 2023-09-20 |