| NPI | 1508079336 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: WV RP0006783) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: OH 03-3-26795) |
| Enumeration Date | 2007-05-08 |
| Last Update Date | 2009-03-03 |