| NPI | 1023467891 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: OH 03334376) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: KY 014429) |
| Enumeration Date | 2016-06-12 |
| Last Update Date | 2016-06-12 |