| NPI | 1114909165 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MT 3236) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: CA 29074) |
| 183500000X Pharmacist (Licence: NY 028512-1) | |
| Enumeration Date | 2005-11-16 |
| Last Update Date | 2007-07-08 |