| NPI | 1972783124 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NY 049365-1) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: PA RP438978) |
| Enumeration Date | 2007-11-05 |
| Last Update Date | 2007-11-05 |