| NPI | 1942411053 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: WV rp0005438) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: OH 03-3-19902) |
| Enumeration Date | 2007-05-24 |
| Last Update Date | 2026-05-14 |