| NPI | 1700161692 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NY 2056202) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: FL PS39800) |
| Enumeration Date | 2011-10-11 |
| Last Update Date | 2015-08-25 |