| NPI | 1760705305 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NY 049327) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: CT PCT9552) |
| Enumeration Date | 2010-03-10 |
| Last Update Date | 2010-03-10 |