| NPI | 1891140539 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: WV RP0007186) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: OH 03329131) |
| Enumeration Date | 2016-05-02 |
| Last Update Date | 2016-05-02 |