| NPI | 1104923804 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NY 028085) |
| Additional Taxonomies | 282N00000X General Acute Care Hospital (Licence: NY 028085) |
| Enumeration Date | 2006-09-17 |
| Last Update Date | 2007-07-08 |