| NPI | 1003167487 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NY 057778) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MA PH234360) |
| Enumeration Date | 2012-09-26 |
| Last Update Date | 2015-08-14 |