| NPI | 1497047112 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: VT 033-0002889) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NY I036415) |
| Enumeration Date | 2011-05-13 |
| Last Update Date | 2023-12-05 |