| NPI | 1902448699 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NC 29466) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NY 066305) |
| Enumeration Date | 2019-10-14 |
| Last Update Date | 2021-08-13 |