| NPI | 1003064536 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NY 048000) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: FL PS35701) |
| Enumeration Date | 2008-09-09 |
| Last Update Date | 2010-03-23 |