| NPI | 1871011403 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: OH 03237184) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MI 5302042268) |
| Enumeration Date | 2017-09-04 |
| Last Update Date | 2025-05-15 |