| NPI | 1821154048 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: PA RP437194) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NY 051675) |
| Enumeration Date | 2006-12-29 |
| Last Update Date | 2007-11-26 |