| NPI | 1811130503 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: OH 03-1-11082) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: KY 006996) |
| Enumeration Date | 2009-04-11 |
| Last Update Date | 2009-04-11 |