| NPI | 1063734465 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NY 045754) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: CT 0008241) |
| Enumeration Date | 2010-02-25 |
| Last Update Date | 2010-02-25 |