| NPI | 1033798210 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NY 069582) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NJ 28RI04160200) |
| Enumeration Date | 2021-04-06 |
| Last Update Date | 2026-05-18 |