| NPI | 1649873159 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NY 067327) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: PA rp453150) |
| Enumeration Date | 2020-11-17 |
| Last Update Date | 2020-11-17 |