| NPI | 1598181653 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NY 062628) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: WA PH 60413390) |
| Enumeration Date | 2014-03-13 |
| Last Update Date | 2021-10-12 |