| NPI | 1356782957 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NY 055751) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: AZ S021886) |
| Enumeration Date | 2013-07-11 |
| Last Update Date | 2016-10-12 |