| NPI | 1629108980 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1835G0303X Pharmacist Geriatric (Licence: NY 022792-1) |
| Additional Taxonomies | 1835G0303X Pharmacist Geriatric (Licence: FL PS38328) |
| Enumeration Date | 2007-03-06 |
| Last Update Date | 2007-07-23 |