| NPI | 1003330598 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NY 057722) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NY 57722) |
| Enumeration Date | 2017-07-27 |
| Last Update Date | 2017-07-27 |