| NPI | 1114026622 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NY 047198) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: FL PS34614) |
| Enumeration Date | 2006-09-21 |
| Last Update Date | 2016-07-22 |