| NPI | 1508149329 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1835P0018X Pharmacist Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist (Licence: NY 051924) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NY 051924) |
| Enumeration Date | 2011-09-28 |
| Last Update Date | 2012-07-10 |