| NPI | 1316339815 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: OH 03328619) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: KY 014091) |
| Enumeration Date | 2015-02-21 |
| Last Update Date | 2023-08-07 |