| NPI | 1366824567 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NY 060153-1) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: CT 0012927) |
| Enumeration Date | 2015-06-24 |
| Last Update Date | 2015-06-24 |