| NPI | 1164889846 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: OH RPH.03234168-2) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: KY 016585) |
| 183500000X Pharmacist (Licence: WV RP0008095) | |
| Enumeration Date | 2016-01-26 |
| Last Update Date | 2016-01-26 |