| NPI | 1902199003 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: OH 03124022) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: WV RP0007343) |
| Enumeration Date | 2011-05-23 |
| Last Update Date | 2011-05-23 |