| NPI | 1942485628 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NY 051086-1) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NY I051086) |
| Enumeration Date | 2007-12-31 |
| Last Update Date | 2025-08-18 |