| NPI | 1528339181 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: WV RP0005208) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: OH RPH. 03225087) |
| Enumeration Date | 2012-01-13 |
| Last Update Date | 2012-01-13 |