| NPI | 1164308748 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NY 072897) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: VT 033.0135772) |
| Enumeration Date | 2025-08-11 |
| Last Update Date | 2025-08-11 |