| NPI | 1164412938 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NY 29662) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 1220) |
| Enumeration Date | 2005-10-24 |
| Last Update Date | 2007-07-10 |