| NPI | 1083755045 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 333600000X Pharmacy (Licence: OH 02-0428650) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: OH 03-3-11833) |
| 332B00000X Durable Medical Equipment & Medical Supplies | |
| Enumeration Date | 2007-02-10 |
| Last Update Date | 2007-07-09 |