| NPI | 1023473634 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NJ 28RI03610200) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NY 060637-1) |
| Enumeration Date | 2015-12-24 |
| Last Update Date | 2022-01-22 |