| NPI | 1508460510 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: PA RP452806) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: OH 03338157) |
| 183500000X Pharmacist (Licence: WV RP0011163) | |
| Enumeration Date | 2020-11-30 |
| Last Update Date | 2020-11-30 |