| NPI | 1326318106 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: OH 03230445) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: WV RP0007470) |
| Enumeration Date | 2012-01-10 |
| Last Update Date | 2023-03-07 |