| NPI | 1124311808 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NY I055691) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: PA RP444780) |
| Enumeration Date | 2011-05-27 |
| Last Update Date | 2011-09-05 |