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 |