| NPI | 1457766719 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NY 060074) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: PA rp448131) |
| Enumeration Date | 2014-06-25 |
| Last Update Date | 2022-06-20 |