| NPI | 1982996013 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: OH 03122345) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: WV rp0007591) |
| Enumeration Date | 2011-05-09 |
| Last Update Date | 2011-05-09 |