| NPI | 1568745784 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: OH 03116294) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: KY 014383) |
| Enumeration Date | 2011-09-23 |
| Last Update Date | 2011-09-23 |