| NPI | 1598038499 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: OH 03440486) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MI 5302038131) |
| Enumeration Date | 2012-02-23 |
| Last Update Date | 2025-06-20 |