| NPI | 1417120205 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NY 047484) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: GA RPH023796) |
| 183500000X Pharmacist (Licence: FL PS43085) | |
| Enumeration Date | 2008-04-11 |
| Last Update Date | 2010-11-04 |