| NPI | 1366895468 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NY 061630) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: CT 0012911) |
| Enumeration Date | 2016-07-13 |
| Last Update Date | 2016-07-13 |