| NPI | 1972051050 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: OH 03114842) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: WV RP0004805) |
| Enumeration Date | 2016-09-16 |
| Last Update Date | 2016-09-16 |