| NPI | 1497282545 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1835P2201X Pharmacist Ambulatory Care (Licence: OH 03236712) |
| Additional Taxonomies | 171000000X Military Health Care Provider |
| Enumeration Date | 2017-05-20 |
| Last Update Date | 2023-06-07 |