| NPI | 1336757319 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NY 064741) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: CT PCT.0015396) |
| Enumeration Date | 2020-07-16 |
| Last Update Date | 2020-07-23 |