| NPI | 1518419050 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: OH 03132219) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: KY 016144) |
| Enumeration Date | 2016-11-01 |
| Last Update Date | 2022-03-09 |