| NPI | 1366852006 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: OH 34329) |
| Additional Taxonomies | 1835P1200X Pharmacist, Pharmacotherapy (Licence: MI 5302040059) |
| 183500000X Pharmacist (Licence: KY 017477) | |
| Enumeration Date | 2014-05-03 |
| Last Update Date | 2015-02-09 |