| NPI | 1003124058 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: KY 011967) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NY 042920) |
| Enumeration Date | 2010-09-23 |
| Last Update Date | 2020-05-07 |