| NPI | 1710201090 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NY 044188) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: VA 0202204106) |
| Enumeration Date | 2010-03-16 |
| Last Update Date | 2010-03-16 |