| NPI | 1952739286 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NJ 28RI03586600) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NY 058447) |
| 183500000X Pharmacist (Licence: OH 03338092) | |
| 183500000X Pharmacist (Licence: KY 020207) | |
| 146N00000X Emergency Medical Technician, Basic (Licence: NY 429736) | |
| 183500000X Pharmacist (Licence: FL PS52841) | |
| Enumeration Date | 2013-10-23 |
| Last Update Date | 2023-03-28 |