| NPI | 1417523515 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: WA 61099454) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: OH 03440520) |
| Enumeration Date | 2021-05-28 |
| Last Update Date | 2023-10-30 |