| NPI | 1902407075 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: OH 03219464) |
| Additional Taxonomies | 333600000X Pharmacy (Licence: OH 03219464) |
| Enumeration Date | 2020-11-05 |
| Last Update Date | 2020-11-05 |