| NPI | 1215280011 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NY 056554) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: CT PCT.0011842) |
| Enumeration Date | 2012-10-18 |
| Last Update Date | 2012-10-18 |