| NPI | 1316450430 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NY 068494) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: TX 61353) |
| Enumeration Date | 2017-11-10 |
| Last Update Date | 2022-04-18 |