| NPI | 1619124450 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NY 050214) |
| Additional Taxonomies | 3336C0003X Pharmacy Community/Retail Pharmacy (Licence: NY 027749) |
| Enumeration Date | 2008-08-22 |
| Last Update Date | 2008-08-22 |