| NPI | 1225381692 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NY 057151) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NJ 28RI03530600) |
| 183500000X Pharmacist (Licence: FL PS49839) | |
| Enumeration Date | 2012-10-22 |
| Last Update Date | 2013-07-26 |