| NPI | 1619309234 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: AZ S019910) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NY 058001) |
| Enumeration Date | 2013-08-06 |
| Last Update Date | 2015-07-02 |