| NPI | 1659854750 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MD 13836) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NY 043526) |
| Enumeration Date | 2018-09-13 |
| Last Update Date | 2018-09-13 |