| NPI | 1912986670 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NY 054244) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NJ 28R102717400) |
| 183500000X Pharmacist (Licence: NY I054244-1) | |
| Enumeration Date | 2006-01-11 |
| Last Update Date | 2019-12-16 |