| NPI | 1407985294 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: FL ps0028402) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NY 042116-1) |
| Enumeration Date | 2007-03-05 |
| Last Update Date | 2007-07-08 |