| NPI | 1992292379 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: WV RP0007171) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: OH 03129921) |
| 183500000X Pharmacist (Licence: KY 015864) | |
| Enumeration Date | 2018-04-20 |
| Last Update Date | 2018-04-20 |