| NPI | 1932381274 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NY 050649) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MD 16892) |
| Enumeration Date | 2007-11-28 |
| Last Update Date | 2007-11-28 |