| NPI | 1508042243 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NY I051747) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: PA RP448133) |
| Enumeration Date | 2008-01-11 |
| Last Update Date | 2013-10-14 |