| NPI | 1467154690 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MA PH27354) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NY 038076) |
| Enumeration Date | 2023-03-21 |
| Last Update Date | 2023-03-21 |