| NPI | 1629560628 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NY 064024) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: OH 03236695) |
| 183500000X Pharmacist (Licence: IL 051295855) | |
| Enumeration Date | 2018-06-05 |
| Last Update Date | 2018-11-26 |