| NPI | 1104141100 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NY 050728) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: FL 36278) |
| Enumeration Date | 2010-04-01 |
| Last Update Date | 2010-04-01 |