| NPI | 1427476282 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: AZ S013157) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NY 031032-1) |
| Enumeration Date | 2014-03-30 |
| Last Update Date | 2014-03-30 |