| NPI | 1063643765 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MD 23612) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NY 053567) |
| 183500000X Pharmacist (Licence: IL 051294560) | |
| 183500000X Pharmacist (Licence: VA 0202212511) | |
| 183500000X Pharmacist (Licence: DC PH100002199) | |
| Enumeration Date | 2009-07-30 |
| Last Update Date | 2019-05-16 |