| NPI | 1780678060 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: OH 03-1-24661) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: OH 03124661) |
| Enumeration Date | 2005-09-01 |
| Last Update Date | 2021-05-10 |