| NPI | 1972121010 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NY 063971) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: CT 15467) |
| Enumeration Date | 2020-07-06 |
| Last Update Date | 2026-01-15 |