| NPI | 1912340688 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NY 057807) |
| Additional Taxonomies | 163WD0400X Registered Nurse, Diabetes Educator (Licence: NY 057807) |
| Enumeration Date | 2013-04-12 |
| Last Update Date | 2020-12-31 |