| NPI | 1902828122 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NY 041092) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: PA RP036691L) |
| Enumeration Date | 2006-07-24 |
| Last Update Date | 2007-07-08 |