| NPI | 1881068161 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NY 064901) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: FL PS54229) |
| Enumeration Date | 2015-11-24 |
| Last Update Date | 2026-05-12 |