| NPI | 1205184520 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1835P0018X Pharmacist, Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist (Licence: OH 03132330) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: OH 003674) |
| Enumeration Date | 2012-08-16 |
| Last Update Date | 2015-11-07 |