| NPI | 1538208665 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NY 052192-1) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: DE A1-0003645) |
| 183500000X Pharmacist (Licence: MD 18017) | |
| 183500000X Pharmacist (Licence: SC 35823) | |
| Enumeration Date | 2007-02-05 |
| Last Update Date | 2019-11-30 |