| NPI | 1760866966 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1835P2201X Pharmacist Ambulatory Care (Licence: OH 03136299) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NC 24254) |
| Enumeration Date | 2015-07-17 |
| Last Update Date | 2020-03-04 |