| NPI | 1679201248 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1835P2201X Pharmacist, Ambulatory Care (Licence: MO 2023010206) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: OH 03442369) |
| Enumeration Date | 2022-08-11 |
| Last Update Date | 2025-09-02 |