| NPI | 1508291899 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NY 055728) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: PA RP447448) |
| 183500000X Pharmacist (Licence: CT 0012550) | |
| 183500000X Pharmacist (Licence: MA PH234571) | |
| Enumeration Date | 2013-09-05 |
| Last Update Date | 2013-09-05 |