| NPI | 1558049379 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NV 24169) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NY 070401) |
| Enumeration Date | 2023-07-11 |
| Last Update Date | 2024-07-16 |