| NPI | 1538386099 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: OH 03-2-14023) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: WV rp0003939) |
| Enumeration Date | 2007-04-19 |
| Last Update Date | 2007-07-08 |