| NPI | 1952600272 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NY 20 056491) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: VA 0202208252) |
| Enumeration Date | 2011-03-25 |
| Last Update Date | 2014-05-20 |