| NPI | 1558708388 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NY 060360) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NJ 28RI03706400) |
| 183500000X Pharmacist (Licence: NC 23208) | |
| Enumeration Date | 2013-06-03 |
| Last Update Date | 2020-12-27 |