| NPI | 1538379995 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: OH 03-1-10948) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: OH 45953) |
| Enumeration Date | 2007-05-23 |
| Last Update Date | 2007-07-09 |