| NPI | 1174972244 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: CT 0012914) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NY 060145) |
| Enumeration Date | 2016-06-08 |
| Last Update Date | 2016-06-08 |