| NPI | 1881633626 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NY 047583) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NH R2084) |
| Enumeration Date | 2006-06-06 |
| Last Update Date | 2016-03-04 |