| NPI | 1366776635 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NY 053565) |
| Additional Taxonomies | 1835P1200X Pharmacist, Pharmacotherapy (Licence: NY 053565) |
| Enumeration Date | 2009-09-19 |
| Last Update Date | 2012-01-24 |