| NPI | 1356997522 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: WV RP0011751) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: OH 03439104) |
| Enumeration Date | 2019-08-14 |
| Last Update Date | 2019-08-14 |