| NPI | 1205656782 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: WV rp0004854) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: OH 03318779) |
| Enumeration Date | 2024-10-10 |
| Last Update Date | 2024-10-10 |