| NPI | 1629349162 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: WV RP0006638) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: OH RPH. 03230747) |
| Enumeration Date | 2012-01-13 |
| Last Update Date | 2012-12-02 |