| NPI | 1184068827 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: CT 10063) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NY 048796) |
| Enumeration Date | 2013-04-24 |
| Last Update Date | 2020-11-26 |