| NPI | 1699045591 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: VA 0202211604) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NY 056372) |
| Enumeration Date | 2012-01-09 |
| Last Update Date | 2014-01-15 |