| NPI | 1851776470 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: KY 020406) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: OH 03334752) |
| Enumeration Date | 2015-07-24 |
| Last Update Date | 2026-05-06 |