| NPI | 1225814056 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1835P1300X Pharmacist, Psychiatric (Licence: OH 03445874) |
| Additional Taxonomies | 1835P1300X Pharmacist, Psychiatric (Licence: MI 5302415471) |
| Enumeration Date | 2023-09-07 |
| Last Update Date | 2026-09-15 |