| NPI | 1386889830 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NY 050512) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MD 14650) |
| Enumeration Date | 2008-12-12 |
| Last Update Date | 2022-04-07 |