| NPI | 1770805095 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: TN 42241) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NY 052646) |
| Enumeration Date | 2010-03-01 |
| Last Update Date | 2020-11-13 |