| NPI | 1497767008 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NY 042084) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: FL PS28202) |
| Enumeration Date | 2006-08-12 |
| Last Update Date | 2007-07-08 |