| NPI | 1093270126 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NJ 28RI04198500) |
| Additional Taxonomies | 183700000X Pharmacy Technician (Licence: NJ 28RW03598200) |
| Enumeration Date | 2019-02-03 |
| Last Update Date | 2022-09-12 |