| NPI | 1700175544 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: OH 03230396) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: KY 013188) |
| 183500000X Pharmacist (Licence: WV RP0006592) | |
| Enumeration Date | 2011-04-01 |
| Last Update Date | 2011-04-01 |