| NPI | 1124143342 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: SC 11693) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NY 035258) |
| 183500000X Pharmacist (Licence: MA 18058) | |
| Enumeration Date | 2007-03-20 |
| Last Update Date | 2010-08-06 |