| NPI | 1457470957 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NY 069015) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NC 16889) |
| Enumeration Date | 2007-03-28 |
| Last Update Date | 2024-05-15 |