| NPI | 1194027375 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NY 046879) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: FL PS38510) |
| Enumeration Date | 2010-11-22 |
| Last Update Date | 2020-10-15 |