| NPI | 1114585692 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NY 065509) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: PA RP452664) |
| Enumeration Date | 2019-05-30 |
| Last Update Date | 2019-07-28 |