| NPI | 1013524990 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MD 30586) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NY 069321) |
| Enumeration Date | 2020-09-25 |
| Last Update Date | 2026-06-16 |