| NPI | 1356635320 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NY 040201) |
| Additional Taxonomies | 1835P1200X Pharmacist, Pharmacotherapy (Licence: NY 040201) |
| Enumeration Date | 2011-06-07 |
| Last Update Date | 2011-06-07 |