| NPI | 1720115678 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NY 046118) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: SC 12331) |
| Enumeration Date | 2007-02-27 |
| Last Update Date | 2011-09-22 |