| NPI | 1215068952 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: CT 6688) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NY 047052) |
| Enumeration Date | 2007-03-07 |
| Last Update Date | 2017-12-13 |