| NPI | 1467609222 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NC 14596) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NY 045986) |
| Enumeration Date | 2008-08-24 |
| Last Update Date | 2008-08-24 |