| NPI | 1003138520 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NY 047858-1) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: HI 18230) |
| Enumeration Date | 2010-02-25 |
| Last Update Date | 2025-12-23 |