| NPI | 1417112079 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NY 0502371) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: PA RP440846) |
| 183500000X Pharmacist (Licence: FL PS37804) | |
| Enumeration Date | 2008-07-23 |
| Last Update Date | 2013-12-14 |