| NPI | 1144688359 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: KY 012949) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: OH 03326744) |
| Enumeration Date | 2016-02-02 |
| Last Update Date | 2016-02-04 |