| NPI | 1265841191 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: AZ S020741) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NY I059342) |
| Enumeration Date | 2014-08-05 |
| Last Update Date | 2018-08-22 |