| NPI | 1578664595 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: OH 03-3-25685) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: KY 012539) |
| Enumeration Date | 2006-09-25 |
| Last Update Date | 2007-07-08 |