| NPI | 1912205444 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: OH 03225265) |
| Additional Taxonomies | 3336C0002X Pharmacy, Clinic Pharmacy (Licence: OH 03225265) |
| Enumeration Date | 2011-03-08 |
| Last Update Date | 2026-06-17 |