| NPI | 1952246605 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NY 073946) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MD 30881) |
| Enumeration Date | 2026-04-21 |
| Last Update Date | 2026-05-20 |