| NPI | 1235134388 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | |
| Primary Taxonomy | 183500000X Pharmacist (Licence: FL PS12127) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NY 022280-1) |
| Enumeration Date | 2005-06-16 |
| Last Update Date | 2007-07-08 |