| NPI | 1750653416 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NY 057929) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MI 5302040874) |
| Enumeration Date | 2012-01-27 |
| Last Update Date | 2015-04-24 |