| NPI | 1487924882 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NY 35808) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: FL PS28499) |
| Enumeration Date | 2012-01-03 |
| Last Update Date | 2020-11-18 |