| NPI | 1235312075 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NY 042090) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: CT pct.ooo7877) |
| Enumeration Date | 2007-12-16 |
| Last Update Date | 2007-12-16 |