| NPI | 1689967952 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NC 19160) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NY 047569) |
| Enumeration Date | 2011-05-19 |
| Last Update Date | 2023-06-27 |