| NPI | 1114466141 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NY I066444) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: TX 68258) |
| 183500000X Pharmacist (Licence: NJ 28RI03691000) | |
| Enumeration Date | 2017-02-23 |
| Last Update Date | 2024-07-25 |