| NPI | 1275825820 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: WV 3789) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: OH 03327070) |
| 183500000X Pharmacist (Licence: KY 013954) | |
| Enumeration Date | 2011-05-13 |
| Last Update Date | 2011-05-13 |