| NPI | 1023596202 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NJ 28RI04232500) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: CT PCT.0014493) |
| Enumeration Date | 2018-07-31 |
| Last Update Date | 2023-06-26 |