| NPI | 1275717381 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NY 000161) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MI 5302035079) |
| Enumeration Date | 2007-12-26 |
| Last Update Date | 2007-12-26 |