| NPI | 1336421791 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: WV RP0009380) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: OH 03135356) |
| Enumeration Date | 2011-09-12 |
| Last Update Date | 2019-05-29 |