| NPI | 1457172579 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NY 072168) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: TX 75582) |
| Enumeration Date | 2024-10-21 |
| Last Update Date | 2026-06-13 |