| NPI | 1164992012 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NY 040273) |
| Additional Taxonomies | 1835G0303X Pharmacist, Geriatric (Licence: DC 9104820) |
| 1835P1200X Pharmacist, Pharmacotherapy (Licence: DC 302003009) | |
| Enumeration Date | 2018-12-04 |
| Last Update Date | 2018-12-04 |