| NPI | 1295904407 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NY 050559) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: DE aA1-0003895) |
| Enumeration Date | 2008-02-21 |
| Last Update Date | 2011-04-12 |