| NPI | 1093038903 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NY 44313) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NV 12232) |
| Enumeration Date | 2010-03-05 |
| Last Update Date | 2010-03-05 |