| NPI | 1962866137 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NY 060505) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: FL 54592) |
| Enumeration Date | 2016-04-13 |
| Last Update Date | 2016-04-13 |