| NPI | 1336580042 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: FL PS 34352) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NY 046977-1) |
| Enumeration Date | 2013-07-10 |
| Last Update Date | 2014-05-22 |