| NPI | 1548667298 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NY 059986) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: WA PH60648906) |
| Enumeration Date | 2014-11-24 |
| Last Update Date | 2019-02-19 |