| NPI | 1407137748 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: OH 03-1-22920) |
| Additional Taxonomies | 177F00000X Lodging (Licence: OH 03122920) |
| Enumeration Date | 2011-08-31 |
| Last Update Date | 2024-12-17 |