| NPI | 1215435599 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NY 064275) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: KS 1-102926) |
| 183500000X Pharmacist (Licence: MO 2017025931) | |
| Enumeration Date | 2018-01-31 |
| Last Update Date | 2020-01-27 |