| NPI | 1952678872 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: OH 03228264) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: OH pt009519) |
| Enumeration Date | 2011-11-21 |
| Last Update Date | 2011-11-21 |