| NPI | 1518676048 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1835P2201X Pharmacist Ambulatory Care (Licence: OH 0213907) |
| Additional Taxonomies | 1835P2201X Pharmacist Ambulatory Care (Licence: OH 13907) |
| 225100000X Physical Therapist (Licence: OH 13907) | |
| Enumeration Date | 2022-11-23 |
| Last Update Date | 2022-11-23 |