| NPI | 1093424681 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NY 069931) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NJ 28RI04350200) |
| Enumeration Date | 2022-11-22 |
| Last Update Date | 2024-08-10 |