| NPI | 1700174539 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1835G0303X Pharmacist, Geriatric (Licence: WY 9103911) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NY 054562) |
| Enumeration Date | 2011-07-14 |
| Last Update Date | 2024-01-16 |