| NPI | 1679026835 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: OH 03135544) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: KY 018613) |
| Enumeration Date | 2016-07-24 |
| Last Update Date | 2016-07-24 |