| NPI | 1629360227 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NC 18272) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NY 048093) |
| Enumeration Date | 2011-05-14 |
| Last Update Date | 2011-05-14 |