| NPI | 1164631206 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: OH 03-1-22747) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: OH 03122747) |
| Enumeration Date | 2007-05-22 |
| Last Update Date | 2020-05-11 |