| NPI | 1689109449 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MA 236942) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NY 061160) |
| Enumeration Date | 2017-04-28 |
| Last Update Date | 2021-03-24 |