| NPI | 1912256066 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: FL PS57719) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NY 057242) |
| Enumeration Date | 2012-09-05 |
| Last Update Date | 2020-11-20 |