| NPI | 1356302889 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: VT 033-0003368) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NY 045591-1) |
| Enumeration Date | 2006-04-02 |
| Last Update Date | 2020-01-14 |