| NPI | 1952582884 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NY 044478) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NV 14548) |
| Enumeration Date | 2007-11-20 |
| Last Update Date | 2016-01-07 |