| NPI | 1639598360 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: FL PS36478) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: PA RP444157) |
| 183500000X Pharmacist (Licence: NY 042269) | |
| Enumeration Date | 2014-04-09 |
| Last Update Date | 2020-05-12 |