| NPI | 1235552480 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: AZ T012410) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NY 039981) |
| Enumeration Date | 2014-01-23 |
| Last Update Date | 2014-01-23 |