| NPI | 1699866517 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: TX 47561) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: FL PS38904) |
| 183500000X Pharmacist (Licence: NJ 28R103560100) | |
| 183500000X Pharmacist (Licence: NY 20 057987) | |
| Enumeration Date | 2006-09-27 |
| Last Update Date | 2022-01-21 |