| NPI | 1851803076 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NY 063584) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: FL PS54086) |
| Enumeration Date | 2017-10-27 |
| Last Update Date | 2018-03-17 |