| NPI | 1487101846 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NY I058825) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: TX 55691) |
| Enumeration Date | 2016-09-02 |
| Last Update Date | 2016-09-02 |