| NPI | 1164797353 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1835G0303X Pharmacist, Geriatric (Licence: WI 15547-40) |
| Additional Taxonomies | 1835G0303X Pharmacist, Geriatric (Licence: OH 03129816) |
| Enumeration Date | 2012-03-20 |
| Last Update Date | 2012-03-20 |