| NPI | 1134719594 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MA PH237762) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NY 065049) |
| Enumeration Date | 2021-01-20 |
| Last Update Date | 2021-01-20 |