| NPI | 1063772408 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NY 056712) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NJ 28RI03343300) |
| Enumeration Date | 2012-05-19 |
| Last Update Date | 2023-08-24 |