| NPI | 1528650413 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1835P2201X Pharmacist, Ambulatory Care (Licence: OH 03439948) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: OH 03439948) |
| Enumeration Date | 2021-02-11 |
| Last Update Date | 2022-03-31 |