| NPI | 1497374870 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: OH 0323351) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: PA RP444894) |
| 183500000X Pharmacist (Licence: WV RP0008286) | |
| Enumeration Date | 2020-04-15 |
| Last Update Date | 2020-04-15 |