| NPI | 1225401219 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: VT 033.0134102) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NY 061088) |
| Enumeration Date | 2015-11-12 |
| Last Update Date | 2019-08-19 |