| NPI | 1396035671 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NC 34460) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: OH 03445427) |
| 183500000X Pharmacist (Licence: NJ 28RI03416300) | |
| Enumeration Date | 2011-04-07 |
| Last Update Date | 2026-09-08 |