| NPI | 1073896262 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NY 045817) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NC 18060) |
| Enumeration Date | 2011-09-23 |
| Last Update Date | 2020-07-07 |