| NPI | 1528410941 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NY 061713) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NC 29944) |
| 183500000X Pharmacist (Licence: CO 23915) | |
| Enumeration Date | 2016-07-09 |
| Last Update Date | 2023-03-15 |