| NPI | 1477236107 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NY 072452) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: FL PS69972) |
| 183500000X Pharmacist (Licence: TX 76709) | |
| 183500000X Pharmacist (Licence: NJ 28RI04498700) | |
| Enumeration Date | 2023-08-09 |
| Last Update Date | 2026-06-10 |