| NPI | 1861602914 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: FL PS0023060) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NY 037746) |
| Enumeration Date | 2007-05-23 |
| Last Update Date | 2011-09-02 |