| NPI | 1760749410 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MD 20291) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NY 056550) |
| Enumeration Date | 2012-04-19 |
| Last Update Date | 2012-04-19 |