| NPI | 1346843505 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: OH 03337873) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MO 2015030924) |
| Enumeration Date | 2020-11-19 |
| Last Update Date | 2023-07-04 |