| NPI | 1306492004 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: OH 03438726) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: FL PS70592) |
| Enumeration Date | 2019-08-18 |
| Last Update Date | 2026-09-04 |