| NPI | 1952908600 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: OH 03439840) |
| Additional Taxonomies | 1835N1003X Pharmacist Nutrition Support (Licence: OH 03439840) |
| 1835P1200X Pharmacist Pharmacotherapy (Licence: OH 03439840) | |
| 208U00000X Clinical Pharmacology (Licence: OH 03439840) | |
| 333600000X Pharmacy | |
| 3336C0004X Pharmacy Compounding Pharmacy | |
| 3336H0001X Pharmacy Home Infusion Therapy Pharmacy | |
| 3336S0011X Pharmacy Specialty Pharmacy | |
| Enumeration Date | 2020-10-06 |
| Last Update Date | 2020-10-06 |