| NPI | 1255454492 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: OH RPH.03230464-2) |
| Additional Taxonomies | 183700000X Pharmacy Technician (Licence: OH 330101051152863) |
| Enumeration Date | 2007-04-10 |
| Last Update Date | 2011-03-18 |