| NPI | 1477070001 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MI 5302035271) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: OH 03227912-2) |
| Enumeration Date | 2017-08-24 |
| Last Update Date | 2026-01-26 |