| NPI | 1366008070 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1835G0303X Pharmacist, Geriatric (Licence: OH 03135790) |
| Additional Taxonomies | 1835G0303X Pharmacist, Geriatric (Licence: KY 018652) |
| Enumeration Date | 2019-05-17 |
| Last Update Date | 2019-05-17 |