| NPI | 1235311804 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NY 33244) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: PA RP439461) |
| 183500000X Pharmacist (Licence: CT PCT.0010177) | |
| Enumeration Date | 2007-12-05 |
| Last Update Date | 2011-10-14 |