| NPI | 1679905285 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: CT 7209) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NY 38206) |
| Enumeration Date | 2013-08-06 |
| Last Update Date | 2013-08-06 |