| NPI | 1659876928 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NY 063081-1) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NC 25265) |
| 1835P2201X Pharmacist, Ambulatory Care (Licence: NY 063081-1) | |
| Enumeration Date | 2018-03-28 |
| Last Update Date | 2018-03-28 |