| NPI | 1376854000 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NC 21554) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NY 054560) |
| Enumeration Date | 2010-06-28 |
| Last Update Date | 2014-05-07 |