| NPI | 1093105694 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NY 064016) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MA PH238065) |
| 183500000X Pharmacist (Licence: CT PCT.0013746) | |
| Enumeration Date | 2015-02-03 |
| Last Update Date | 2024-08-04 |