| NPI | 1649824020 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 333600000X Pharmacy (Licence: NY 065507) |
| Additional Taxonomies | 3336C0003X Pharmacy, Community/Retail Pharmacy (Licence: NY 065507) |
| Enumeration Date | 2019-07-24 |
| Last Update Date | 2019-07-24 |