| NPI | 1225215890 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NY 051591-1) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: PA RP439275) |
| Enumeration Date | 2008-01-26 |
| Last Update Date | 2008-01-26 |