| NPI | 1518850585 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: OH 03445971) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MI 5302416713) |
| Enumeration Date | 2025-05-30 |
| Last Update Date | 2026-04-22 |