| NPI | 1669978946 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NM RP00010052) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: SC 43395) |
| 183500000X Pharmacist (Licence: OH 03136123) | |
| 183500000X Pharmacist (Licence: PA RP448970) | |
| Enumeration Date | 2018-04-04 |
| Last Update Date | 2025-12-29 |