| NPI | 1528712684 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: OH 15865) |
| Additional Taxonomies | 333600000X Pharmacy (Licence: OH 15865) |
| Enumeration Date | 2022-02-08 |
| Last Update Date | 2022-02-08 |