| NPI | 1205381209 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: DC PH100002455) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MD 24310) |
| 183500000X Pharmacist (Licence: NY 061897) | |
| Enumeration Date | 2016-08-18 |
| Last Update Date | 2016-08-18 |