| NPI | 1770036329 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: VA 0202215164) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NY 061899) |
| Enumeration Date | 2016-08-01 |
| Last Update Date | 2016-08-01 |