| NPI | 1548547896 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: OH 03312952) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: WV RP0003779) |
| 183500000X Pharmacist (Licence: VA 0202007653) | |
| 183500000X Pharmacist (Licence: NC 09478) | |
| Enumeration Date | 2011-11-14 |
| Last Update Date | 2011-11-14 |