| NPI | 1629391255 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: SC 12693) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: OH RPH.03129456-1) |
| Enumeration Date | 2010-03-10 |
| Last Update Date | 2026-05-13 |