| NPI | 1508142191 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: OH 03335204) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: KY 15144) |
| Enumeration Date | 2011-10-26 |
| Last Update Date | 2021-04-27 |