| NPI | 1245608876 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MD 23624) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NY 064111) |
| Enumeration Date | 2015-09-14 |
| Last Update Date | 2023-08-23 |