| NPI | 1831862887 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NY 072078) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: ME PR70511) |
| 183500000X Pharmacist (Licence: RI RPH06364) | |
| Enumeration Date | 2021-07-27 |
| Last Update Date | 2024-12-19 |