| NPI | 1235340712 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: HI 1388) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NY 34238) |
| Enumeration Date | 2007-05-25 |
| Last Update Date | 2007-07-08 |