| NPI | 1265757223 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: VT 033-0003660) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NY 54252) |
| Enumeration Date | 2010-04-02 |
| Last Update Date | 2010-09-23 |