| NPI | 1750605184 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NY 042312) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: AZ S010316) |
| 183500000X Pharmacist (Licence: VT 033.0135992) | |
| Enumeration Date | 2010-03-13 |
| Last Update Date | 2026-04-02 |