| NPI | 1275913741 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NY 059010-1) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: VT 033.0101708) |
| 183500000X Pharmacist (Licence: UT 7000548-01701) | |
| Enumeration Date | 2015-05-31 |
| Last Update Date | 2015-05-31 |