| NPI | 1780048470 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: FL ps0029119) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NY 042729) |
| Enumeration Date | 2016-04-08 |
| Last Update Date | 2016-04-08 |