| NPI | 1083254809 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NJ 28RI03940700) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NY 066242) |
| Enumeration Date | 2020-01-09 |
| Last Update Date | 2020-12-16 |