| NPI | 1083465868 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NY 048906) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MA PH25117) |
| Enumeration Date | 2024-03-29 |
| Last Update Date | 2024-03-29 |