| NPI | 1598078370 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: VT 033.0068302) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NY 054621) |
| Enumeration Date | 2010-07-21 |
| Last Update Date | 2012-08-07 |