| NPI | 1013221753 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: OH 03328618) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: KY 014793) |
| Enumeration Date | 2010-08-05 |
| Last Update Date | 2010-08-05 |