| NPI | 1174705123 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NY 045658-i) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NY 048658) |
| Enumeration Date | 2007-12-01 |
| Last Update Date | 2020-10-19 |