| NPI | 1184037780 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: WV RP0004450) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: OH 03-2-16649) |
| Enumeration Date | 2014-06-11 |
| Last Update Date | 2014-06-11 |