| NPI | 1639499916 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: KY 014573) |
| Additional Taxonomies | 1835P2201X Pharmacist, Ambulatory Care (Licence: KY 014573) |
| Enumeration Date | 2010-06-09 |
| Last Update Date | 2018-02-16 |