| NPI | 1689908246 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NY 058841) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: ME pr5745) |
| Enumeration Date | 2009-09-29 |
| Last Update Date | 2025-01-22 |