| NPI | 1205111523 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NY 047181) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: CT 5673) |
| Enumeration Date | 2011-10-18 |
| Last Update Date | 2023-11-13 |