| NPI | 1124302724 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: KY 015639) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: OH 03438475) |
| Enumeration Date | 2011-10-01 |
| Last Update Date | 2025-12-10 |