| NPI | 1831375922 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: PA MD028175-E) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NY 027388-1) |
| 183500000X Pharmacist (Licence: PA RP-045854-R) | |
| Enumeration Date | 2008-01-18 |
| Last Update Date | 2008-01-18 |