| NPI | 1154506848 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: FL ps54550) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NY 036779) |
| 183500000X Pharmacist (Licence: NV 10512) | |
| Enumeration Date | 2008-01-01 |
| Last Update Date | 2019-01-23 |