| NPI | 1811088289 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NY 069008) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: FL 36199) |
| Enumeration Date | 2006-09-28 |
| Last Update Date | 2023-02-12 |