| NPI | 1770768707 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: SC 12395) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NY 028526-1) |
| Enumeration Date | 2008-01-09 |
| Last Update Date | 2012-10-29 |