| NPI | 1780862482 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NY 48431) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: FL PS44209) |
| Enumeration Date | 2008-02-05 |
| Last Update Date | 2020-11-12 |