| NPI | 1649371899 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: OH 03114864) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: OH 36002590) |
| Enumeration Date | 2006-09-26 |
| Last Update Date | 2013-03-20 |