| NPI | 1295301869 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NY I067264) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: ID P8823) |
| Enumeration Date | 2021-06-03 |
| Last Update Date | 2022-06-27 |