| NPI | 1255686481 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NY 056770) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: CA 68695) |
| Enumeration Date | 2012-07-13 |
| Last Update Date | 2025-03-01 |