| NPI | 1336741347 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: OH 03439486) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: WV rp0012074) |
| Enumeration Date | 2020-11-13 |
| Last Update Date | 2020-11-13 |