| NPI | 1053399808 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: OH 03221271) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: PA RP438933) |
| 1835G0303X Pharmacist, Geriatric (Licence: OH 0296) | |
| Enumeration Date | 2006-01-03 |
| Last Update Date | 2025-09-11 |