| NPI | 1073221404 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: OH 03438306) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: GA RPH17937) |
| Enumeration Date | 2022-11-15 |
| Last Update Date | 2022-11-15 |