| NPI | 1801480066 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 3336C0003X Pharmacy Community/Retail Pharmacy (Licence: AZ S026425) |
| Additional Taxonomies | 310400000X Assisted Living Facility (Licence: AZ AL6397H) |
| Enumeration Date | 2021-02-26 |
| Last Update Date | 2023-10-23 |