| NPI | 1013234111 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: SC 11186) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NY 32378) |
| Enumeration Date | 2010-04-28 |
| Last Update Date | 2010-04-28 |