| NPI | 1396078861 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NY 045156) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: TX 37750) |
| Enumeration Date | 2009-09-15 |
| Last Update Date | 2009-09-15 |