| NPI | 1174769913 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: WV RP0006924) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: OH RPH 03127374-1) |
| Enumeration Date | 2008-12-29 |
| Last Update Date | 2008-12-29 |