| NPI | 1053048538 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MA ph240941) |
| Additional Taxonomies | 1835P1300X Pharmacist, Psychiatric (Licence: NY 070285) |
| Enumeration Date | 2022-08-04 |
| Last Update Date | 2026-05-22 |