| NPI | 1679987697 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: KY 015233) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: OH 03230261-2) |
| Enumeration Date | 2014-06-18 |
| Last Update Date | 2014-06-18 |