| NPI | 1871777359 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: WI 12261-040) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NY 040089) |
| Enumeration Date | 2007-12-20 |
| Last Update Date | 2007-12-20 |