| NPI | 1538525688 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NY 065297) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: PA RP449671) |
| Enumeration Date | 2016-01-05 |
| Last Update Date | 2020-01-27 |