| NPI | 1578856787 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NY 043626-1) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NY 00894248) |
| Enumeration Date | 2011-05-20 |
| Last Update Date | 2011-05-20 |