| NPI | 1881129450 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NY 057911) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: CT PCT. 0011454) |
| Enumeration Date | 2017-04-20 |
| Last Update Date | 2019-11-21 |