| NPI | 1891239612 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NY 061245) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: PA RP450803) |
| Enumeration Date | 2016-12-13 |
| Last Update Date | 2019-12-13 |