| NPI | 1518237809 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: DE A1-0003717) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NY 20 055189) |
| Enumeration Date | 2012-01-04 |
| Last Update Date | 2015-09-14 |