| NPI | 1639447188 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NY 061617) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MD 19788) |
| Enumeration Date | 2011-12-12 |
| Last Update Date | 2017-10-10 |