| NPI | 1275596033 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NC 18182) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NY 047658) |
| 183500000X Pharmacist (Licence: VA 0202207454) | |
| Enumeration Date | 2006-04-11 |
| Last Update Date | 2025-07-10 |