| NPI | 1689677338 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: KY 015314) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: OH 03-1-09903) |
| Enumeration Date | 2005-05-24 |
| Last Update Date | 2014-10-24 |