| NPI | 1184965873 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA A159614) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NY 057714) |
| Enumeration Date | 2013-03-06 |
| Last Update Date | 2023-07-28 |