| NPI | 1306441340 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: PA RP453911) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NJ 28RI04069900) |
| 183500000X Pharmacist (Licence: VA 0202221874) | |
| Enumeration Date | 2020-11-30 |
| Last Update Date | 2025-08-13 |