| NPI | 1003219296 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: VT 033.0105560) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NY 059687) |
| Enumeration Date | 2014-10-01 |
| Last Update Date | 2014-10-01 |