| NPI | 1861741654 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: WV RP0007510) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: OH 03230921) |
| Enumeration Date | 2012-09-07 |
| Last Update Date | 2022-12-13 |