| NPI | 1639745052 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: KY 020896) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: OH 03444796) |
| Enumeration Date | 2021-05-27 |
| Last Update Date | 2026-03-11 |