| NPI | 1710772124 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NY 072618) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: ID 8971556) |
| Enumeration Date | 2025-04-14 |
| Last Update Date | 2025-05-15 |