| NPI | 1225065378 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: OH 03-01-17450) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: WV RP0006608) |
| 183500000X Pharmacist (Licence: OH 03117450) | |
| Enumeration Date | 2006-06-26 |
| Last Update Date | 2023-02-07 |