| NPI | 1508848441 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: NY 217818) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NY 038101) |
| Enumeration Date | 2005-11-16 |
| Last Update Date | 2015-11-20 |