| NPI | 1265156657 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: PA RP458749) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NY 069559) |
| Enumeration Date | 2022-09-28 |
| Last Update Date | 2025-11-26 |