| NPI | 1306444005 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NY 066709) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: CO PHA.0025102) |
| Enumeration Date | 2020-10-14 |
| Last Update Date | 2026-03-19 |