| NPI | 1316540891 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: OH 03233734) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: KY 017263) |
| Enumeration Date | 2020-11-18 |
| Last Update Date | 2022-10-26 |