| NPI | 1194132399 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NY 059339) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NY 589925) |
| Enumeration Date | 2014-07-20 |
| Last Update Date | 2014-07-20 |