| NPI | 1639476096 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MD 19034) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NH 3604) |
| 183500000X Pharmacist (Licence: NY 055323) | |
| Enumeration Date | 2011-02-22 |
| Last Update Date | 2025-10-08 |