| NPI | 1831114016 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NY 047549) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MA ph26915) |
| 183500000X Pharmacist (Licence: FL PS46014) | |
| Enumeration Date | 2006-07-12 |
| Last Update Date | 2010-07-09 |