| NPI | 1811597289 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: OH 03331151) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: WV rp0007690) |
| Enumeration Date | 2020-10-27 |
| Last Update Date | 2020-10-27 |