| NPI | 1598210445 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NY I062106-1) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NC 26482) |
| Enumeration Date | 2016-08-22 |
| Last Update Date | 2022-07-21 |