| NPI | 1871250431 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NY 067543) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: CT PCT.0014620) |
| Enumeration Date | 2021-11-18 |
| Last Update Date | 2021-11-18 |