| NPI | 1790868131 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: SC 011919) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NY 034038) |
| 183500000X Pharmacist (Licence: PA RP440014) | |
| Enumeration Date | 2006-10-21 |
| Last Update Date | 2016-02-24 |