| NPI | 1962797555 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: OH 03318304) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: KY 012310) |
| Enumeration Date | 2011-06-13 |
| Last Update Date | 2011-06-13 |