| NPI | 1700165495 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NY 050707) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MA 232340) |
| Enumeration Date | 2011-08-11 |
| Last Update Date | 2012-09-04 |