| NPI | 1083896963 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: PA RP029528L) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NY 032567) |
| Enumeration Date | 2007-12-03 |
| Last Update Date | 2007-12-03 |