| NPI | 1952745481 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: OH 03233825) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: KY 020469) |
| Enumeration Date | 2013-04-26 |
| Last Update Date | 2019-03-07 |