| NPI | 1295777233 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1835G0303X Pharmacist, Geriatric (Licence: MA 26695) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NY 33882) |
| 183500000X Pharmacist (Licence: KY 9433) | |
| 183500000X Pharmacist (Licence: VT 033-0003364) | |
| Enumeration Date | 2006-06-12 |
| Last Update Date | 2025-09-11 |