| NPI | 1700869658 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1835P1200X Pharmacist, Pharmacotherapy (Licence: SC 5767) |
| Additional Taxonomies | 1835P1200X Pharmacist, Pharmacotherapy (Licence: OH 03322200) |
| Enumeration Date | 2005-11-23 |
| Last Update Date | 2007-07-08 |