| NPI | 1942473095 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: CO 10670) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NY 46743-1) |
| Enumeration Date | 2008-04-09 |
| Last Update Date | 2008-04-09 |