| NPI | 1225211618 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: AZ S023445) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NY 047360) |
| Enumeration Date | 2007-12-10 |
| Last Update Date | 2023-09-26 |