| NPI | 1871771956 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NY 041027) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: FL ps44635) |
| Enumeration Date | 2008-01-31 |
| Last Update Date | 2022-12-19 |