| NPI | 1013379312 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NY 061408) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: CT PCT.0013125) |
| Enumeration Date | 2016-03-25 |
| Last Update Date | 2017-02-12 |