| NPI | 1932554268 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: WV RP0009303) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: OH 03335261) |
| Enumeration Date | 2016-04-23 |
| Last Update Date | 2016-04-23 |