| NPI | 1831630318 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: OH 022525700-03) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: WV 0008602) |
| Enumeration Date | 2017-03-16 |
| Last Update Date | 2017-03-16 |