| NPI | 1174365597 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NY 071497) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: FL PS66945) |
| Enumeration Date | 2024-06-07 |
| Last Update Date | 2024-06-07 |