| NPI | 1144659442 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NC 23740) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NY 058284) |
| Enumeration Date | 2013-11-06 |
| Last Update Date | 2013-11-06 |