| NPI | 1033453915 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NY 057933) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: FL PS48812) |
| Enumeration Date | 2012-11-16 |
| Last Update Date | 2014-02-20 |