| NPI | 1699167981 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: OH 03315880) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: KY 013051) |
| 183500000X Pharmacist (Licence: FL PS22345) | |
| Enumeration Date | 2015-02-24 |
| Last Update Date | 2015-02-24 |