| NPI | 1356733208 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: OH 03232794) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: KY 016569) |
| Enumeration Date | 2015-03-02 |
| Last Update Date | 2015-03-02 |