| NPI | 1194249029 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1835P2201X Pharmacist, Ambulatory Care (Licence: OH 03440031) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: WV RP0010250) |
| Enumeration Date | 2017-08-02 |
| Last Update Date | 2020-08-21 |