| NPI | 1528119856 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: OH 03-1-24778) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: KY 012193) |
| Enumeration Date | 2007-01-15 |
| Last Update Date | 2007-07-08 |