| NPI | 1285238170 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NY 066748) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MA PH239769) |
| 183500000X Pharmacist (Licence: VT 033.0134630) | |
| Enumeration Date | 2020-11-23 |
| Last Update Date | 2025-12-31 |