| NPI | 1043738552 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MI 5302032124) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NY 049673) |
| Enumeration Date | 2017-09-05 |
| Last Update Date | 2020-06-02 |