| NPI | 1760866206 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NY 060499) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: CO 0020790) |
| Enumeration Date | 2015-07-15 |
| Last Update Date | 2015-07-16 |