| NPI | 1699098996 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NY 043312) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MA 19325) |
| Enumeration Date | 2010-03-01 |
| Last Update Date | 2010-03-01 |