| NPI | 1023326865 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NC 16576) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NY 044375-1) |
| 183500000X Pharmacist (Licence: MA 22386) | |
| Enumeration Date | 2010-09-14 |
| Last Update Date | 2010-09-14 |