| NPI | 1396923819 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NY I051456-1) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MA PH25521) |
| Enumeration Date | 2008-02-06 |
| Last Update Date | 2010-02-11 |