| NPI | 1003152281 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NY 056510) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: VT 033.0047442) |
| Enumeration Date | 2012-12-17 |
| Last Update Date | 2012-12-17 |