| NPI | 1215259544 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MA PH23202) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NY 052149-1) |
| 183500000X Pharmacist (Licence: NH 3076) | |
| Enumeration Date | 2010-03-01 |
| Last Update Date | 2023-01-26 |