| NPI | 1033267539 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MA 19147) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NY 25889) |
| 183500000X Pharmacist (Licence: CT 5178) | |
| Enumeration Date | 2007-01-08 |
| Last Update Date | 2007-07-08 |