| NPI | 1184877805 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NY 049468-1) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: PA RP037118L) |
| Enumeration Date | 2008-10-25 |
| Last Update Date | 2021-01-07 |