| NPI | 1396067674 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NY 053987) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MA PH27496) |
| Enumeration Date | 2010-02-27 |
| Last Update Date | 2014-07-18 |