| NPI | 1013439546 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NY 062926) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: FL PS55747) |
| Enumeration Date | 2017-07-17 |
| Last Update Date | 2019-09-17 |