| NPI | 1326328162 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: CT pct.0011612) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NY 055211-1) |
| Enumeration Date | 2011-08-24 |
| Last Update Date | 2012-05-07 |