| NPI | 1407142060 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NY 059108) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: PA rp444949) |
| Enumeration Date | 2011-06-22 |
| Last Update Date | 2020-01-22 |