| NPI | 1770942955 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: KY 008491) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: OH 03212601) |
| Enumeration Date | 2016-02-17 |
| Last Update Date | 2016-02-17 |