| NPI | 1134656754 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1835P1200X Pharmacist, Pharmacotherapy (Licence: OH 03225276) |
| Additional Taxonomies | 1835P1200X Pharmacist, Pharmacotherapy (Licence: MI 5302034062) |
| Enumeration Date | 2017-05-13 |
| Last Update Date | 2021-03-30 |