| NPI | 1366810947 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: CT 9728) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NY 047094) |
| Enumeration Date | 2015-09-12 |
| Last Update Date | 2015-09-12 |