| NPI | 1477438992 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: WI 12457-40) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MI 5302416176) |
| 183500000X Pharmacist (Licence: PA rp041810l) | |
| 183500000X Pharmacist (Licence: OH 03444817) | |
| Enumeration Date | 2025-08-06 |
| Last Update Date | 2025-08-06 |