| NPI | 1326007048 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: OH 03-2-16395) |
| Additional Taxonomies | 225000000X Orthotic Fitter (Licence: OH C15650) |
| Enumeration Date | 2006-03-21 |
| Last Update Date | 2007-07-08 |