| NPI | 1871072918 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NY 064294) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: FL PS51193) |
| Enumeration Date | 2018-08-09 |
| Last Update Date | 2019-04-26 |