| NPI | 1972482404 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MO 2026009418) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NY 072908) |
| Enumeration Date | 2025-08-28 |
| Last Update Date | 2026-07-13 |