| NPI | 1952149304 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NY 071511) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: RI 6633) |
| 183500000X Pharmacist (Licence: MA PH1000548) | |
| Enumeration Date | 2024-07-18 |
| Last Update Date | 2024-07-18 |