| NPI | 1104164425 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: OH 03230256) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: WV RP0007746) |
| Enumeration Date | 2013-01-21 |
| Last Update Date | 2018-03-17 |