| NPI | 1124623848 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NY 064298) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: FL Ps54136) |
| Enumeration Date | 2020-12-01 |
| Last Update Date | 2020-12-01 |