| NPI | 1023655487 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: CT 0014509) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NY 067620) |
| Enumeration Date | 2019-12-04 |
| Last Update Date | 2023-11-03 |