| NPI | 1295426906 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: OH 03441486) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NY 070782) |
| Enumeration Date | 2023-05-15 |
| Last Update Date | 2026-08-25 |