| NPI | 1316251481 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: FL PS47225) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NY 054794) |
| Enumeration Date | 2010-08-01 |
| Last Update Date | 2013-06-27 |