| NPI | 1760891857 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NC 24351) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NY 067808) |
| Enumeration Date | 2014-08-04 |
| Last Update Date | 2021-07-27 |