| NPI | 1467564963 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NC 28023) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NY 045752) |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2019-07-13 |