| NPI | 1336468388 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: CT 007610) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NY 025486-1) |
| Enumeration Date | 2010-05-28 |
| Last Update Date | 2010-05-28 |