| NPI | 1922345388 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: OH 03439227) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NY 660419-1) |
| Enumeration Date | 2013-01-04 |
| Last Update Date | 2020-11-23 |