| NPI | 1629314570 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1835G0303X Pharmacist, Geriatric (Licence: OH 03-1-17524) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: OH 03117524) |
| Enumeration Date | 2012-12-21 |
| Last Update Date | 2024-06-10 |