| NPI | 1275985962 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NY 059945) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: OH 03335169) |
| Enumeration Date | 2016-07-06 |
| Last Update Date | 2016-07-06 |