| NPI | 1881941391 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: TX 51384) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NH PHCY-05718) |
| Enumeration Date | 2012-08-14 |
| Last Update Date | 2026-02-13 |