| NPI | 1881919991 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: CT 6827) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NY 039043-1) |
| Enumeration Date | 2010-03-31 |
| Last Update Date | 2014-12-02 |