| NPI | 1053912543 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: OH 03232846) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: KY 016817) |
| Enumeration Date | 2020-11-03 |
| Last Update Date | 2020-11-03 |