| NPI | 1902131816 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NY 025421) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NY 25421) |
| Enumeration Date | 2009-10-09 |
| Last Update Date | 2009-10-09 |