| NPI | 1427150176 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: FL PS21058) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NY 035822-1) |
| Enumeration Date | 2006-09-02 |
| Last Update Date | 2011-03-18 |