| NPI | 1104149913 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NY 054238-1) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: VT 033.0047423) |
| Enumeration Date | 2010-03-08 |
| Last Update Date | 2016-12-29 |