| NPI | 1871044008 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: WV RP0009912) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: OH 03236494) |
| Enumeration Date | 2016-10-24 |
| Last Update Date | 2016-11-18 |