| NPI | 1679879894 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NY 055437) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NJ 28RI03391900) |
| 183500000X Pharmacist (Licence: VT 033.0134885) | |
| Enumeration Date | 2011-02-04 |
| Last Update Date | 2023-07-03 |