| NPI | 1679030118 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NY 059041-1) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: GA RPH017843) |
| Enumeration Date | 2019-02-20 |
| Last Update Date | 2019-02-20 |