| NPI | 1467053959 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: OH 03442161) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NY 067070) |
| Enumeration Date | 2020-11-03 |
| Last Update Date | 2023-06-12 |