| NPI | 1114474665 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: OH 03232908) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: WV RP0009707) |
| Enumeration Date | 2016-09-01 |
| Last Update Date | 2016-09-01 |