| NPI | 1972945848 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: SC 14256) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NY 058000) |
| Enumeration Date | 2013-07-22 |
| Last Update Date | 2014-09-04 |