| NPI | 1124397849 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NY 057668) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NJ 28RI03472100) |
| 183500000X Pharmacist (Licence: PA RP446114) | |
| 183500000X Pharmacist (Licence: MI 5302039593) | |
| 183500000X Pharmacist (Licence: TX 57842) | |
| Enumeration Date | 2011-12-27 |
| Last Update Date | 2016-03-21 |