| NPI | 1851631501 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NY 057812) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: TX 52359) |
| 183500000X Pharmacist (Licence: CT PCT.0012374) | |
| Enumeration Date | 2013-02-17 |
| Last Update Date | 2013-02-17 |