| NPI | 1750987343 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: CT PCT.0014121) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NY 069160) |
| Enumeration Date | 2020-12-08 |
| Last Update Date | 2026-09-03 |