| NPI | 1972596559 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1835P2201X Pharmacist, Ambulatory Care (Licence: NY I052236) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NC 13083) |
| 183500000X Pharmacist (Licence: AR 8705) | |
| Enumeration Date | 2005-08-29 |
| Last Update Date | 2019-03-21 |