| NPI | 1811969629 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: OH 03-2-23663) |
| Additional Taxonomies | 1835P2201X Pharmacist, Ambulatory Care (Licence: OH 03223663) |
| Enumeration Date | 2006-02-06 |
| Last Update Date | 2021-02-03 |