| NPI | 1154720365 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NY 062886) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: PA RP448690) |
| Enumeration Date | 2014-08-14 |
| Last Update Date | 2019-09-13 |