| NPI | 1275787046 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NY 030050) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: CT 0004429) |
| Enumeration Date | 2008-11-06 |
| Last Update Date | 2011-08-18 |