| NPI | 1316307630 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NY 053330) |
| Additional Taxonomies | 1835G0303X Pharmacist, Geriatric (Licence: NY 053330) |
| 1835P1200X Pharmacist, Pharmacotherapy (Licence: NY 053330) | |
| Enumeration Date | 2016-02-29 |
| Last Update Date | 2022-12-05 |