| NPI | 1295218055 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NY 066376) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: SC 37895) |
| Enumeration Date | 2018-09-07 |
| Last Update Date | 2024-08-19 |