| NPI | 1265768782 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NY 052587) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: CT PCT.0010914) |
| Enumeration Date | 2009-10-19 |
| Last Update Date | 2009-10-19 |