| NPI | 1730508912 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NC 22115) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NY 056028) |
| Enumeration Date | 2014-04-15 |
| Last Update Date | 2014-04-15 |