| NPI | 1548980592 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1835P1200X Pharmacist Pharmacotherapy (Licence: NY 3169922) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NY 069398) |
| Enumeration Date | 2022-08-30 |
| Last Update Date | 2024-08-27 |