| NPI | 1205151933 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 174400000X Specialist (Licence: NY 05343651) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NY 054365) |
| Enumeration Date | 2010-04-06 |
| Last Update Date | 2019-04-29 |