| NPI | 1114375771 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: WV RP0008740) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: OH 03234213) |
| Enumeration Date | 2016-05-24 |
| Last Update Date | 2016-05-24 |