| NPI | 1922139948 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: CT 08776) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NY 050276) |
| Enumeration Date | 2007-03-08 |
| Last Update Date | 2014-10-02 |