| NPI | 1649277021 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: OH 03-2-13267) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: KY 008940) |
| Enumeration Date | 2005-06-30 |
| Last Update Date | 2007-07-08 |