| NPI | 1700036340 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NY 049864) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MA 25456) |
| Enumeration Date | 2008-09-19 |
| Last Update Date | 2015-07-03 |