| NPI | 1730405317 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: OH RPH 03116314) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: WV RP0003329) |
| Enumeration Date | 2010-04-08 |
| Last Update Date | 2010-04-08 |