| NPI | 1699104810 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NY 058313) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: CA 69975) |
| Enumeration Date | 2013-11-07 |
| Last Update Date | 2013-11-07 |