| NPI | 1053561563 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NY 043393-1) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NC 14728) |
| 183500000X Pharmacist (Licence: FL PS 30134) | |
| Enumeration Date | 2008-09-22 |
| Last Update Date | 2008-09-22 |