| NPI | 1609930908 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NY 041728) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: PA RP037622L) |
| Enumeration Date | 2006-12-20 |
| Last Update Date | 2013-10-01 |