| NPI | 1891670063 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: PA RP454795) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NY 069104-01) |
| Enumeration Date | 2025-08-07 |
| Last Update Date | 2025-08-07 |