| NPI | 1093924219 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1835P1200X Pharmacist, Pharmacotherapy (Licence: NY 041628) |
| Additional Taxonomies | 1835P1200X Pharmacist, Pharmacotherapy (Licence: FL PS 28401) |
| Enumeration Date | 2007-05-22 |
| Last Update Date | 2012-01-06 |