| NPI | 1699101212 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: CT PCT.0011922) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NY 057640-1) |
| Enumeration Date | 2013-09-16 |
| Last Update Date | 2013-09-16 |