| NPI | 1942322169 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: OH 03-2-21881) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: WV RP0006122) |
| 183500000X Pharmacist (Licence: PA RP041106L) | |
| Enumeration Date | 2007-04-06 |
| Last Update Date | 2007-07-08 |