| NPI | 1740507896 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NY 031818-1) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: CT 0008441) |
| Enumeration Date | 2010-04-29 |
| Last Update Date | 2012-11-20 |