| NPI | 1699987057 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NY 049194) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: PA RP437797) |
| 183500000X Pharmacist (Licence: FL PS 37969) | |
| Enumeration Date | 2007-05-05 |
| Last Update Date | 2011-10-25 |