| NPI | 1124116603 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: OH 03316842) |
| Additional Taxonomies | 1835P1200X Pharmacist, Pharmacotherapy (Licence: OH 03316842) |
| Enumeration Date | 2006-10-10 |
| Last Update Date | 2007-07-08 |