| NPI | 1124319934 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: FL PS18086) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NY 21574) |
| 183500000X Pharmacist (Licence: FL PU2053) | |
| Enumeration Date | 2011-04-27 |
| Last Update Date | 2011-04-27 |