| NPI | 1427659937 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: OH 03328847) |
| Additional Taxonomies | 1835P2201X Pharmacist Ambulatory Care (Licence: OH 03328847) |
| 3336C0003X Pharmacy Community/Retail Pharmacy (Licence: OH 03328847) | |
| Enumeration Date | 2020-11-03 |
| Last Update Date | 2022-07-17 |