| NPI | 1700038205 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: CO 15266) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NY 044460) |
| Enumeration Date | 2008-10-15 |
| Last Update Date | 2008-10-15 |