| NPI | 1821654963 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NJ 28RI03865600) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: FL PS58106) |
| 1835P1300X Pharmacist, Psychiatric (Licence: TX 4150562) | |
| Enumeration Date | 2019-05-14 |
| Last Update Date | 2023-08-09 |