| NPI | 1881220671 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NY 065273) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: CA 86192) |
| 183500000X Pharmacist (Licence: AK PD15730) | |
| Enumeration Date | 2020-03-12 |
| Last Update Date | 2024-03-12 |