| NPI | 1417360199 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: VA 0202218240) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NY I057170) |
| Enumeration Date | 2014-06-10 |
| Last Update Date | 2020-11-12 |