| NPI | 1558675504 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NY 054540) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: PA RP443305) |
| Enumeration Date | 2010-08-02 |
| Last Update Date | 2016-05-07 |