| NPI | 1386193696 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: OH 03236379) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: WV 0009883) |
| Enumeration Date | 2016-09-27 |
| Last Update Date | 2016-11-14 |