| NPI | 1053635680 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NY 042772) |
| Additional Taxonomies | 146N00000X Emergency Medical Technician, Basic (Licence: NY 135941) |
| Enumeration Date | 2010-03-25 |
| Last Update Date | 2010-03-25 |