| NPI | 1083617575 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NY 046926) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: FL PS34495) |
| 183500000X Pharmacist (Licence: CA 61098) | |
| Enumeration Date | 2005-05-27 |
| Last Update Date | 2010-03-22 |