| NPI | 1568916344 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NY 064063) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: FL ps55442) |
| Enumeration Date | 2016-08-09 |
| Last Update Date | 2018-09-20 |