| NPI | 1356822407 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NY 066511) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NC 28154) |
| Enumeration Date | 2018-08-27 |
| Last Update Date | 2022-12-12 |