| NPI | 1659399442 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NY 48661) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: TX 43074) |
| Enumeration Date | 2006-07-18 |
| Last Update Date | 2008-11-20 |