| NPI | 1114659190 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: WV RP0012699) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: OH 03441491) |
| Enumeration Date | 2022-06-28 |
| Last Update Date | 2022-06-28 |