| NPI | 1174951784 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NY 057825) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: PA RP445355) |
| 183500000X Pharmacist (Licence: MD 17542) | |
| 183500000X Pharmacist (Licence: NJ 28RI03053400) | |
| Enumeration Date | 2013-10-16 |
| Last Update Date | 2024-05-24 |