| NPI | 1295903813 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NY 042398-1) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: FL PS 28416) |
| Enumeration Date | 2008-02-16 |
| Last Update Date | 2008-02-16 |