| NPI | 1053766378 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NC 25746) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: CT 0010880) |
| 183500000X Pharmacist (Licence: NJ 28RI01906300) | |
| 183500000X Pharmacist (Licence: NY 036174) | |
| Enumeration Date | 2016-04-25 |
| Last Update Date | 2016-04-25 |