| NPI | 1699978635 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: OH RPH.03331431) |
| Additional Taxonomies | 224Z00000X Occupational Therapy Assistant (Licence: OH 03102) |
| Enumeration Date | 2007-06-07 |
| Last Update Date | 2011-12-23 |