| NPI | 1215291505 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NY 057318-I) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NC 22623) |
| Enumeration Date | 2012-07-02 |
| Last Update Date | 2014-12-15 |