| NPI | 1053597559 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NY 049242) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MO 2008014357) |
| Enumeration Date | 2008-01-14 |
| Last Update Date | 2010-10-21 |