| NPI | 1881918969 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: WV rp0004779) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: OH 03119120) |
| 183500000X Pharmacist (Licence: KY 009705) | |
| Enumeration Date | 2010-03-18 |
| Last Update Date | 2010-03-18 |