| NPI | 1255790291 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NY 20061204) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: UT 7339447-1701) |
| 183500000X Pharmacist (Licence: NC 18876) | |
| Enumeration Date | 2016-02-18 |
| Last Update Date | 2016-02-18 |