| NPI | 1831845627 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NM RP00010146) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NY 068889) |
| 183500000X Pharmacist (Licence: KS 1-123042) | |
| Enumeration Date | 2022-03-01 |
| Last Update Date | 2025-01-22 |