| NPI | 1225308240 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: OH 03129746-1) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: WV RP0010645) |
| Enumeration Date | 2012-01-06 |
| Last Update Date | 2019-07-19 |