| NPI | 1700386653 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NY 063878) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NC 27453) |
| Enumeration Date | 2018-02-16 |
| Last Update Date | 2018-02-16 |