| NPI | 1821460924 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: OH 03219643) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: WV RP0006650) |
| Enumeration Date | 2015-10-28 |
| Last Update Date | 2015-10-28 |