| NPI | 1447659701 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: OH 03114944) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: KY 012865) |
| Enumeration Date | 2014-08-22 |
| Last Update Date | 2020-12-26 |