| NPI | 1427371939 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NY 050651) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: SC 9464) |
| 183500000X Pharmacist (Licence: LA 16298) | |
| Enumeration Date | 2010-03-11 |
| Last Update Date | 2014-02-21 |