| NPI | 1437765856 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: OH 03314210) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: WV RP0003946) |
| Enumeration Date | 2020-09-21 |
| Last Update Date | 2020-09-21 |