| NPI | 1891373866 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MD 27770) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NY 067229) |
| Enumeration Date | 2021-03-31 |
| Last Update Date | 2021-03-31 |