| NPI | 1225721095 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1835P2201X Pharmacist, Ambulatory Care (Licence: CT PCT.0016631) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NY 067249) |
| Enumeration Date | 2023-05-30 |
| Last Update Date | 2024-09-05 |