| NPI | 1114334927 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NC 18715) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: SC 11700) |
| 183500000X Pharmacist (Licence: NY 034832) | |
| Enumeration Date | 2014-07-14 |
| Last Update Date | 2014-07-14 |