| NPI | 1063977320 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NJ 28RI01888200) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MD 10576) |
| Enumeration Date | 2019-01-31 |
| Last Update Date | 2019-01-31 |