| NPI | 1255455739 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NY 047890) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: GA RPH023992) |
| Enumeration Date | 2007-03-19 |
| Last Update Date | 2013-01-14 |