| NPI | 1164704763 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NY 056168) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: PA RP451195) |
| Enumeration Date | 2011-09-09 |
| Last Update Date | 2017-02-15 |