| NPI | 1114592441 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1835P2201X Pharmacist, Ambulatory Care (Licence: NY 066099) |
| Additional Taxonomies | 1835P2201X Pharmacist, Ambulatory Care (Licence: WV RP0012738) |
| Enumeration Date | 2021-05-20 |
| Last Update Date | 2022-03-04 |