| NPI | 1992027528 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NY 052477) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: CT PCT.9921) |
| Enumeration Date | 2010-02-23 |
| Last Update Date | 2010-08-19 |