| NPI | 1144437708 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: WV RP0006452) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: OH 03-3-25417) |
| Enumeration Date | 2007-05-16 |
| Last Update Date | 2012-02-01 |