| NPI | 1306034079 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1835P1200X Pharmacist, Pharmacotherapy (Licence: WV RP0006813) |
| Additional Taxonomies | 1835P1200X Pharmacist, Pharmacotherapy (Licence: OH 03-3-26967) |
| Enumeration Date | 2007-10-09 |
| Last Update Date | 2007-10-09 |