| NPI | 1538540786 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NY 060101) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: PR 6175) |
| Enumeration Date | 2015-06-13 |
| Last Update Date | 2015-06-13 |