| NPI | 1104718188 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: OH 03442521) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: KY 012357) |
| Enumeration Date | 2025-07-16 |
| Last Update Date | 2025-07-16 |