| NPI | 1093152928 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NY 057754) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MA 234240) |
| Enumeration Date | 2013-06-01 |
| Last Update Date | 2013-06-01 |