| NPI | 1811357742 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NY 050402-1) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: FL PS 34782) |
| Enumeration Date | 2016-03-04 |
| Last Update Date | 2016-05-14 |