| NPI | 1619516135 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NY 061326) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NJ 28RI03557500) |
| 183500000X Pharmacist (Licence: FL ps50268) | |
| Enumeration Date | 2020-01-01 |
| Last Update Date | 2021-03-19 |