| NPI | 1285960443 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NC 15276) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NY 046501) |
| Enumeration Date | 2009-10-23 |
| Last Update Date | 2014-01-11 |