| NPI | 1508189101 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NY 048921) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: FL 35032) |
| Enumeration Date | 2010-03-10 |
| Last Update Date | 2010-03-10 |