| NPI | 1154813418 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: FL PS20066) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NY 034839) |
| Enumeration Date | 2018-06-03 |
| Last Update Date | 2018-06-16 |