| NPI | 1679989677 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MA PH236760) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NY 090042) |
| Enumeration Date | 2014-07-10 |
| Last Update Date | 2016-10-07 |