| NPI | 1134662539 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: OH 03131663) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: KY 016269) |
| Enumeration Date | 2016-12-02 |
| Last Update Date | 2016-12-02 |