| NPI | 1285048512 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: OH 03135964) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: KY 017066) |
| Enumeration Date | 2014-06-14 |
| Last Update Date | 2020-10-03 |