| NPI | 1306256789 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: OH RPH 03213974) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: WV RP0003795) |
| 183500000X Pharmacist (Licence: NC 14678) | |
| Enumeration Date | 2014-05-06 |
| Last Update Date | 2014-05-06 |