| NPI | 1992986491 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NY 045405) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: FL PS45896) |
| 183500000X Pharmacist (Licence: VA 0202012810) | |
| 183500000X Pharmacist (Licence: PA RP447387) | |
| Enumeration Date | 2007-11-26 |
| Last Update Date | 2014-07-02 |