| NPI | 1184150203 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: OH 03129993) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: WV rp0007772) |
| Enumeration Date | 2017-05-10 |
| Last Update Date | 2017-05-10 |