| NPI | 1255841227 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: WV RP0010191) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: OH RPH.03237558-2) |
| Enumeration Date | 2017-10-04 |
| Last Update Date | 2017-10-04 |