| NPI | 1669659272 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NY 039065-1) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: CT 5375) |
| Enumeration Date | 2008-01-25 |
| Last Update Date | 2011-08-03 |