| NPI | 1215034228 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NY 033758) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NY X06999) |
| Enumeration Date | 2006-09-20 |
| Last Update Date | 2013-01-04 |