| NPI | 1417806530 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: TN 49319) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: OH 03445973) |
| Enumeration Date | 2026-01-22 |
| Last Update Date | 2026-01-22 |