| NPI | 1942809785 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NY 067143) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: TX 68415) |
| Enumeration Date | 2020-10-22 |
| Last Update Date | 2025-11-03 |