| NPI | 1851013668 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NY 069698) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: VT 033.0134789) |
| Enumeration Date | 2022-09-19 |
| Last Update Date | 2022-09-27 |