| NPI | 1225566524 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NY 063133) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MI 5302042568) |
| Enumeration Date | 2017-05-31 |
| Last Update Date | 2022-07-21 |