| NPI | 1912174558 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1835P2201X Pharmacist, Ambulatory Care (Licence: OH 03132030) |
| Additional Taxonomies | 146M00000X Emergency Medical Technician, Intermediate (Licence: OH 0146389) |
| Enumeration Date | 2008-05-13 |
| Last Update Date | 2017-11-01 |