| NPI | 1376935965 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: KY 012876) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: OH 03326751) |
| Enumeration Date | 2015-02-19 |
| Last Update Date | 2023-10-30 |