| NPI | 1285179432 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NY 060063) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: CT 0013185) |
| Enumeration Date | 2016-12-27 |
| Last Update Date | 2016-12-27 |