| NPI | 1730472911 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: OH 03218295) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: WV RP0005089) |
| 183500000X Pharmacist (Licence: MI 53022021353) | |
| Enumeration Date | 2011-05-22 |
| Last Update Date | 2011-05-22 |